Coronary artery disease (CAD)
continues to claim the lives of many
people worldwide and creates
enormous disability for those who
survive. According to World Health
Organization (WHO) estimates,
cardiovascular disease will be the
leading cause of morbidity and
mortality by the year 2020.

Developing countries will be the
major contributor to this increased
death and disability1,2,3,4. These
WHO estimates are expected to affect
the Gulf states in a major way due
to recent evidence of increased risk
factors among populations of the
Gulf countries. There was only few
limited data concerning the
prevalence and the clinical aspects
of CAD in the Kingdom of Saudi
Arabia till recently when Al-Nozha reported a major national
study on CAD in Saudis (CADISS) 5 .
That was a community-based study
conducted by examining subjects in
the age group of 30-70 years between
1995 and 2000.

The overall prevalence of CAD was
5.5%. The prevalence in males and
females were 6.6% and 4.4%,
respectively. The prevalence of CAD
risk factors were as follows:
diabetes mellitus: 23.7%,
hypertension: 26%, current smoking:
12.8%, hypercholesterolemia: 53.9%,
and obesity: 35.6%. Since these data
represent only the prevalence in the
community setting, it is expected
that the prevalence of these factors
are even higher in the hospital
setting when subsequent reports from
the study get published.

Other studies from the Gulf States
indicate a high prevalence rate of
type 2 diabetes among adults
population (15-18%) 6, 7. Obesity is
a growing concern, with increased
rates of obese people among the
general population in some Gulf
states 8,9. Smoking was found to be
widespread among the population in
Kuwait, with about 34% of men
smoking10.

While considerable progress has been
made in developing effective
treatment and therapies for patients
with CAD, significant opportunities
remain to improve the quality of
cardiac care. It is well known that
there is an unacceptable delay
between the availability of
conclusive clinical trial evidence
and its application to patient care.
At the same time, it is challenging
for clinicians to stay current due
to the rapidly increasing volume of
available information. Improving the
quality of care increasingly rests
on the ability to efficiently
translate research knowledge into
practice, so that patients may
benefit sooner from the available
scientific evidence.

There are some well-known registries
of acute coronary syndromes that
have contributed to our
understanding of the distribution of
this disease among different
societies. These registries have
also demonstrated the different
practice patterns of the treatment
of acute coronary syndromes and
their influence on morbidity and
mortality11,12,13. The majority of
these registries represent data from
the developed industrialized
countries.

Phase-I of
SPACE registry started in
December, 2005 and showed the
following results over a 1-year
period:

1588 patients were enrolled from 13
hospitals in Saudi Arabia.
Average age was 58.1 years, 77% of
them were males, and 84% were
Saudis. 38% had prior history of
ischemic heart disease, previous
percutaneous coronary intervention
(13%), diabetes (57%), hypertension
(53%), current smoking (33%),
hyperlipidemia (40%), and family
history of premature CAD (14%).
Median door-to-needle time for
fibrinolytic therapy received by
STEMI patients was 75 minutes.

The pilot phase of the Gulf RACE
project included ACS patients who
were admitted to 65 hospitals in 6
Arabian Gulf countries during the
month of May 2006. A total of 1484
ACS patients were recruited. The
mean age of patients was 55 years,
and 76% of them were men.

Among patients with STEMI and LBBB
MI, the reperfusion rate was 65%,
with use of primary percutaneous
coronary intervention strategy in 7%
and administration of thrombolytic
therapy in 93%.

When thrombolytic therapy was used,
the median door to needle time was
45 minutes, with 37% receiving it
within 30 minutes of hospital
presentation. During the first day
of hospitalization, aspirin was
administered to 94%, clopidogrel to
51%, and beta blockers to 65%.
Angiotensin converting enzyme
inhibitors/Angiotensin receptor
blockers and statins were used in
62% and 82%, respectively. Coronary
angiography during hospitalization
was performed in 21%.

In-hospital mortality rate was 3%.
This project - Gulf A.C.S Registry -
represents a unified program of the
2 registries; i.e: SPACE and Gulf
RACE. Its aim is to assist in
reducing the gap between research
and practice and hence improve the
quality of cardiac care for all
patients with ACS in the Arabian
Gulf countries.